Coping with Alzheimer's

When driving becomes an issue

The freedom to slide behind the wheel of a vehicle, turn the key and drive away symbolizes
many things: independence, convenience and competence. So its
understandable that most of us want to be able to drive as long
as possible. Although advancing age may bring a decrease in
vision and hearing and a slowing of reflexes, most people learn
to compensate for such diminishing abilities. For example, an
older person may decide to drive fewer miles, more slowly and not
at night. Even though its never an easy choice, most people
determine for themselves when its time to limit or stop driving.

When to stop

For a person with Alzheimer's disease, the decision to stop driving is often not
voluntary. Just how long someone with Alzheimer's should be
permitted to drive (if at all) is an issue that stirs the
emotions of those with the disease, their caregivers and the
general public. Although some states, such as California, require
that people with Alzheimer's disease be reported by their
physicians to the state health department and the department of
motor vehicles, most states don't have such requirements.

Increased risk

The risk of being involved in a traffic accident increases with a drivers age. Even
older adult drivers without Alzheimer's disease are more
than twice as likely to be involved in fatal traffic accidents as
are middle-age drivers. According to a study published in the
December 1988 issue of the Annals of Neurology, per mile, people
with Alzheimer's disease are 19 times more likely to have an
accident than an older adult without the disease. Despite this
increased risk, people with Alzheimer's on average drive 2.5
years after their diagnosis &em; even though they may have
significant cognitive impairment and have been advised by a
caregiver to stop.

Surveys indicate the general public prefers that physicians help
keep unfit drivers off the road. However, health care
professionals have conflicting opinions on the subject of when to
take away the keys from people with Alzheimer's. Because the
disease progresses differently in each person, its nearly
impossible to generalize about when people with Alzheimer's
lose their ability to safely handle a motor vehicle. What makes
it even more imprecise is that some people in the early stages of
the disease are still able to pass a driving test.

Psychological tests can help determine whether someone with
Alzheimer's has the memory, perception and coordination
needed to drive safely. But there are no definitive,
quantifiable, standardized tests to pinpoint when driving should
be discouraged or stopped. As a result, caregivers remain
responsible for continually reassessing the driving abilities of
a person with Alzheimer's. As the person becomes more
impaired, the caregiver must balance loss of independence and
dignity against the risk to self and others in making the
decision.

When safety becomes an issue

Knowledge of the rules of the road, good judgment and adequate eyesight, hearing
and coordination are all needed for safe driving. Some experts
say that over the years, the ability to drive is so ingrained
that it becomes somewhat "automatic." Driving skills
seem to be well-preserved into old age in most people.

Most experts agree that even if a person has good coordination
and reasonably sharp senses, when judgment is compromised,
driving becomes unsafe. "Most people with Alzheimer's
disease think they're safe and skillful drivers," says Dr.
Jonathan M. Evans, a specialist in internal medicine and
geriatrics at Mayo Clinic, Rochester, Minn. "What's
interesting is that people with the disease forget that they
can't remember how to make good judgments," Dr. Evans says.
"They lack the insight to voluntarily stop driving."

Warning signs of unsafe driving

If you're the caregiver of someone with Alzheimer's, its up to you to
assess that persons ability to drive. When any one of these signs
is apparent, its time for the person to give up driving:

Inability to locate familiar places

Failure to observe and obey traffic signs and speed limits

Poor or slow decision-making in traffic

Anger, confusion or frustration while driving

"My concern is that real-life driving situations, even in
familiar areas, are not predictable," says Dr. Evans.
"People with Alzheimer's disease are unlikely to be
able to judge or respond quickly. That means they may have
difficulty reacting properly to a situation like a child crossing
in front of them or a car stalled in traffic, even when it
happens on a familiar stretch of road."

Dr. Evans adds that there may be no warning signs of
deteriorating driving skills. He says the unpredictable course of
the disease, with an inevitable decline in cognitive skills and
judgment, are reason enough to advise all people with a diagnosis
of Alzheimer's disease not to drive.

"My opinion is that you can either drive a day longer than
you should and risk a tragedy, or you can stop a day early and
avoid serious injury or death," Dr. Evans says. "As a
physician, it's my responsibility to bring up this issue with the
patient and family. This relieves the caregiver of that
pressure."

One thing is certain. Eventually the physical limitations of the
disease stop everyone with it from driving.